In their postgraduate educational programs, residents are immersed in a complex workplace. To improve the quality of the training program, it is necessary to gain insight into the factors that influence the process of learning in the workplace. An exploratory study was carried out among 56 nursing home physicians in training (NHPT) and 62 supervisors. They participated in semi-structured group interviews, in which they discussed four questions regarding workplace learning. Qualitative analysis of the data was performed to establish a framework of factors that influence workplace learning, within which framework comparisons between groups could be made. A framework consisting of 56 factors was identified. These were grouped into 10 categories, which in turn were grouped into four domains: the working environment, educational factors in the workplace, NHPT characteristics and supervisor characteristics. Of the factors that influence workplace learning, social integration was cited most often. Supervisors more often reported educational factors and NHPTs more frequently reported impediments. Conclusion: The educational relationship may be improved when supervisors explicitly discuss the learning process and learning conditions within the workplace, thereby focusing on the NHPT needs. Special attention should be paid to the aspects of social integration. A good start could be to answer the question regarding how to establish a basic feeling of 'knowing where you are' and 'how to go about things' to make residents feel comfortable enough to focus on the learning process.
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This dissertation presents the results of a research project on unraveling the dynamics of facilitating workplace learning through pedagogic practices in healthcare placements. Supervisors are challenged to foster safe learning opportunities and fully utilize the learning potential of placement through stimulating active participation for students while ensuring quality patient care. In healthcare placements, staff shortages and work pressure may lead to stress when facilitating workplace learning. Enhancing pedagogic practices in healthcare placements seems essential to support students in challenging experiences, such as emotional challenges. This dissertation proposes approaches for optimizing learning experiences for students by highlighting the value of day-to-day work activities and interactions in healthcare placements, and shedding light on agency in workplace learning through supervisor- and student-strategies.
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Background: Clinical reasoning skills are considered to be among the key competencies a physiotherapist should possess. Yet, we know little about how physiotherapy students actually learn these skills in the workplace. A better understanding will benefit physiotherapy education.Objectives: To explore how undergraduate physiotherapy students learn clinical reasoning skills during placements.Design: A qualitative research design using focus groups and semi-structured interviews.Setting: European School of Physiotherapy, Amsterdam, the Netherlands.Participants: Twenty-two undergraduate physiotherapy students and eight clinical teachers participated in this study.Main outcome measures: Thematic analysis of focus groups and semi-structured interviews.Results: Three overarching factors appeared to influence the process of learning clinical reasoning skills: the learning environment, the clinical teacher and the student. Preclinical training failed to adequately prepare students for clinical practice, which expected them to integrate physiotherapeutic knowledge and skills into a cyclic reasoning process. Students’ basic knowledge and assessment structure therefore required further development during the placements. Clinical teachers expected a holistic, multifactorial problem-solving approach from their students. Both students and teachers considered feedback and reflection essential to clinical learning. Barriers to learning experienced by students included time constraints, limited patient exposure and patient communication.Conclusions: Undergraduate physiotherapy students develop clinical reasoning skills through comparison of and reflection on different reasoning approaches observed in professional therapists. Over time, students learn to synthesise these different approaches into their own individual approach. Physiotherapy programme developers should aim to include a wide variety of multidisciplinary settings and patient categories in their clinical placements.
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